Weaning Off the Bottle and the Pacifier

The AAP's safe sleep guidance says to offer a pacifier at nap time and bedtime, because it reduces the risk of SIDS. That is not permission, it is a recommendation, and it holds through the first year when the risk is highest.

Its bottle guidance runs the other way over the same period: offer a cup when your baby starts solids at around six months, and complete the move between twelve and eighteen months. The AAP and the American Academy of Pediatric Dentistry go further and recommend going to a lidless cup by twelve months.

So there is a stretch, roughly six to twelve months, when you are meant to be introducing a cup and retiring the bottle while still putting a pacifier in at bedtime. That is not inconsistent. They do different things: one is a sleep-safety measure, the other is a feeding vessel with a dental cost attached.

The practical rules are short. If you are breastfeeding, wait until it is going well and your baby is gaining weight before introducing one. If you are not, you can start whenever you like.

If the pacifier falls out after your baby has fallen asleep, you do not have to put it back in. This is worth knowing at three in the morning, because a great many parents assume the opposite and spend months reinserting it.

One safety rule is absolute: never use a pacifier that attaches to clothing, a blanket or a stuffed toy. Those are a suffocation and choking risk, and they undo the reason the pacifier was there in the first place.

Teeth, mostly. Early childhood caries, which you will see called baby bottle tooth decay, happens when teeth are constantly bathed in milk, formula or juice. A bottle carried around, sipped through the afternoon or taken to bed does exactly that, and a cup at mealtimes does not.

The other reasons are less dramatic and more common: a child filling up on milk from a bottle between meals eats less at them, and prolonged bottle use is associated with tooth alignment problems. The AAP also makes a point that has nothing to do with health, which is that this gets harder the longer it waits. A fourteen-month-old gives up a bottle more easily than a two-year-old, who now has opinions and a memory.

Gradually, and from the edges inward. The AAP's method is to tell your child that bottles happen at mealtimes, then remove the other bottles one at a time, starting with the ones around naps and bedtime.

That order is deliberate: the bedtime bottle is both the hardest to give up and the worst for teeth, so it goes early rather than last. What replaces it is a routine rather than another drink, a story, a song, a cuddle. The AAP's own suggestion for filling that gap is a pacifier, which is the clearest illustration on this page that the two are not the same problem.

Between meals, the cup should hold water. Milk and formula belong at mealtimes; using a cup or bottle to soothe through the day puts teeth back in the same bath the deadline exists to prevent.

Later, and usually without much intervention. Most children give it up on their own somewhere between two and four years, which is a wide window and a genuinely hands-off one compared with the bottle.

The reason there is no equivalent twelve-month deadline is that a pacifier does not deliver sugar to teeth. Prolonged use into the preschool years is a dental question about how teeth and palate are shaped, and it is one to raise with a dentist about your particular child rather than to solve against a date.

If you are choosing which battle to have first, the answer is the bottle, and it is not close.

Worth mentioning at a checkup: a child past eighteen months still taking most of their liquid from a bottle, a child who takes a bottle to bed, any visible spot or discolouration on a tooth, or a child who will not drink from a cup at all.

A dentist is the right person for the tooth side of this, and the first visit is due earlier than most families expect. Our teething guide covers when, along with what to do about the teeth once they arrive.